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Did you already do an infertility workup? If you can get your doctor to code it as "irregular periods", "endometriosis" or "pelvic pain" you might get a lot of your costs covered by insurance even if you are single. I got all of my workup covered under other diagnoses.
Also have you looked into getting IVF in other countries where it is cheaper? Probably not the safest option, but it depends on the risks you are willing to take to have a child.
Quote:
Originally Posted by miyu
If she has PCOS she has irregular periods. It would be a correct coding. Obviously health insurance people are not qualified to make medical diagnoses, so stick with your field. Seems like she already got the workup anyways. It is her doctor that has to determine what diagnosis to put down based on her symptoms - I was just giving examples of what the diagnoses I was given. But there are many, many diagnoses that could be used for initial workup depending on the presenting complaint.
I'd tell you where to stick your condescending tone, but I think you know. You suggested fraud and then even had the audacity to brag about your hospital "absorbing" costs. Don't try and wave your MD at me because you got caught. I know my job. I know fraud. Submitting diagnoses under false pretenses is...wait for it......FRAUD.
They "absorb the extra costs"? Are they for-profit? If they are a for-profit hospital somebody else (like the regular ol' patients) are paying $5.00 for one aspirin to supplement all this generosity.
Please. Correct me if I'm wrong.
(Dang. Dad was right. I should have gone into medicine.)
This is a non-profit hospital. I think the doctors just don't get paid in full. Kind of like an employee discount. There are different types of healthcare benefits for different types of employees and I probably am one of the lucky ones who get everything for free - probably because I'm getting paid like crap. What goes around comes around. Certainly going into medicine won't get you these benefits.
I think most hospitals charge $5/aspirin regardless of whether it is non profit or for-profit. It's to offset the costs of people on Medicare, Medical, who have no insurance, etc. And the costs of overhead, which most people don't think about.
I'd tell you where to stick your condescending tone, but I think you know. You suggested fraud and then even had the audacity to brag about your hospital "absorbing" costs. Don't try and wave your MD at me because you got caught. I know my job. I know fraud. Submitting diagnoses under false pretenses is...wait for it......FRAUD.
I don't argue with undereducated people who wave their "20 years of insurance experience" at me. LOL. And judgmental too. Wow, can't get better than that. You would not know fraud if it hit you in the face, because your whole field is a fraud and has nothing to contribute to improvement of healthcare.
And who puts "infertility" as an initial diagnosis when it has not been clinically proven, has no definite etiology, and doesn't fit the clinical definition? If you coded a workup as "infertility" it would definitely be FALSE. I am trying my best to explain the clinical side of this but I guess you will never get it.
I don't argue with undereducated people who wave their "20 years of insurance experience" at me. LOL. And judgmental too. Wow, can't get better than that. You would not know fraud if it hit you in the face, because your whole field is a fraud.
It was my job for 3 years of my career, of course I don't know it.
You know it, you just won't come off your high horse and admit it. If a patient does not present with endometriosis, you cannot code it. And you most certainly cannot code pelvic pain and do a complete infertility workup.
Your initial post was questioning if she already had the workup. Why was that? Because you know full well if she already had than there is a history of an infertility diag in her medical records so her Dr cannot hide the workup under another diagnosis which is what you were insinuating she should do. Now you are waving your MD and acting like you know it all because you got backed into a corner thinking it would get fluffed off and nobody would notice. Again. Fraud.
My field is a fraud? Yes, you are right. The companies that pay your salary is fraudulent.
I don't argue with undereducated people who wave their "20 years of insurance experience" at me. LOL. And judgmental too. Wow, can't get better than that. You would not know fraud if it hit you in the face, because your whole field is a fraud and has nothing to contribute to improvement of healthcare.
And who puts "infertility" as an initial diagnosis when it has not been clinically proven, has no definite etiology, and doesn't fit the clinical definition? If you coded a workup as "infertility" it would definitely be FALSE. I am trying my best to explain the clinical side of this but I guess you will never get it.
Who? The ethical doctors do. It is also REQUIRED according to billing guidelines.
It was my job for 3 years of my career, of course I don't know it.
You know it, you just won't come off your high horse and admit it. If a patient does not present with endometriosis, you cannot code it. And you most certainly cannot code pelvic pain and do a complete infertility workup.
Your initial post was questioning if she already had the workup. Why was that? Because you know full well if she already had than there is a history of an infertility diag in her medical records so her Dr cannot hide the workup under another diagnosis which is what you were insinuating she should do. Now you are waving your MD and acting like you know it all because you got backed into a corner thinking it would get fluffed off and nobody would notice. Again. Fraud.
My field is a fraud? Yes, you are right. The companies that pay your salary is fraudulent.
Can you even name what is included in a "complete infertility workup"? There is much overlap between the diagnoses. I can most definitely order one under the simple diagnosis of painful/irregular periods (which are real symptoms) and much of it will get covered. What is fraudulent about that? If that is inappropriate how come the insurance people who are supposedly so sharp at detecting fraud are still making payments? Obviously if somebody is at the point where they are TREATING for diagnosed infertility they would have to code it as such because there is no way insurance would pay for IVF/IUI anyways, unless it is covered in their plan. You can't trick them that easily.
The reason I questioned her workup is because there are a few infertility specialists out there who do not do a decent workup. They use a shotgun approach assuming that all people have the same issues. After 1-2 years you can give somebody a clinical diagnosis of "infertility" (just based on timeframe passed) but do you know the reason behind the infertility? So how do you treat if you aren't sure an appropriate workup is done? It's a waste of time and money to treat blindly. I wanted to confirm as no info was given at the time of my post.
Insurance companies may pay most doctors, but they do not pay my salary at this time, sorry to say. I have my own funding. They did pay yours though.
Who? The ethical doctors do. It is also REQUIRED according to billing guidelines.
I'd like to see these guidelines. So if I'm concerned about my fertility I can't get diagnosis/treatment for other things of concern, like irregular bleeding, pain, or anything overlapping at all?
I'm sure that is what the insurance companies would LOOOOVE to see happen.
Can you even name what is included in a "complete infertility workup"? There is much overlap between the diagnoses. I can most definitely order one under the simple diagnosis of painful/irregular periods (which are real symptoms) and much of it will get covered. What is fraudulent about that? If that is inappropriate how come the insurance people who are supposedly so sharp at detecting fraud are still making payments?
The reason I questioned her workup is because there are a few infertility specialists out there who do not do a decent workup. They use a shotgun approach assuming that all people have the same issues. After 1-2 years you can give somebody a clinical diagnosis of "infertility" but do you know the reason behind it? So how do you treat if you aren't sure an appropriate workup is done? It's a waste of time and money to treat blindly.
Insurance companies may pay most doctors, but they do not pay my salary at this time, sorry to say. I have my own funding. They did pay yours though.
FSH, TSH, BBT, ULH, Estradiol for labs or would you like to talk about hysterosalpingograms and other more invasive tests?
You certainly can code under pelvic pain/irregular periods but if ANY test is done to investigate any possibility of infertility it needs to have the secondary diag of infertility. It is done ALL the time. I don't pretend to know even 5% of what a Dr knows, I do know how to smell a rat though.
That is not why you questioned it and you know it and I know it. I am not going to have an ethical debate with you about insurance coding and billing. If there is one thing I have learned over all these years, there are a lot of bad apples out there in MD land.
I'd like to see these guidelines. So if I'm concerned about my fertility I can't get diagnosis/treatment for other things of concern, like irregular bleeding, pain, or anything overlapping at all?
I'm sure that is what the insurance companies would LOOOOVE to see happen.
Ask the people who do your billing to show you. You certainly can have the tests but there needs to be a secondary diag of infertility.
I actually live in a state where a lot of infertility is covered and it is mandated for all fully insured products. If it is a self-funded policy it is up to the company you work for to elect infertility coverage. if they have not, and your Dr hides the code, you are also ripping off the company that you work for who is actually paying the bills. Even better.
This is a non-profit hospital. I think the doctors just don't get paid in full. Kind of like an employee discount. There are different types of healthcare benefits for different types of employees and I probably am one of the lucky ones who get everything for free - probably because I'm getting paid like crap. What goes around comes around. Certainly going into medicine won't get you these benefits.
I think most hospitals charge $5/aspirin regardless of whether it is non profit or for-profit. It's to offset the costs of people on Medicare, Medical, who have no insurance, etc. And the costs of overhead, which most people don't think about.
Unless you are working at a clinic in Mississippi or the inner-city I highly doubt you are getting paid "like crap". I know what doctors make at the major non-profits. Especially in your supposed speciality. It's not crap. Also know how hospital overhead works, but that's for another thread.
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